When I was in graduate school, I was taught that to be a good clinician…you must be able to look in the mirror and acknowledge when you messed up or that what you are doing is not working. I do not think I am being too controversial when I say that the existing treatment models for addiction are not good enough. When we have a 90% relapse rate for meth and heroin…we know we are not doing something right. I also can acknowledge that the state of addiction treatment in this country is not affordable for most people and insurance is as stubborn as ever in paying for anything that is not outpatient based.
So I owe it to my clients to be honest with my own displeasure with the state of addiction treatment and I am trying to be part of the solution. It is easy to define addiction as the person on television who lives on the street and has track marks on their arm, but addiction does not have to be about skid row and physical dependence. Addiction can also include the definition abuse, which is the continued use of a substance or behavior despite all of the negative consequences that result.
I believe that addiction is a combination of social pressures, poor emotion regulation skills/trauma history, underlying mental illness, and simply people like to feel good. While the social piece is way beyond my role and pay grade, it is my job to help my clients and their families understand why somebody has a problem with addiction (substances, sex, gambling, computer, internet) and what underlying factors might be contributing to it. I am up to date on the latest brain research on addiction and as a result I choose interventions that account for the neurological piece such as Dialectical Behavior Therapy, Neuro/Bio Feedback, Nutrition, and even Medication Management referrals.
I also believe strongly in the research that clearly shows that it is not education about the negative effects of drugs that works, but rather the higher the perceived risk (legal, financial, educational) to an addict, the less likely they are to continue an addictive behavior. This is why for younger clients, family involvement is essential in helping set boundaries and making sure they are being part of the solution and not enabling the behaviors.